Sørensen Anita Rath, Thulstrup Ane Marie, Hansen Johnni, Ramlau-Hansen Cecilia Høst, Meersohn Andrea, Skytthe Axel, Bonde Jens Peter
Aarhus University Hospital, Department of Occupational Medicine, Aarhus, Denmark.
Scand J Work Environ Health. 2007 Oct;33(5):379-86. doi: 10.5271/sjweh.1157.
Whether the elevated risk of lung cancer observed among welders is caused by welding emissions or by confounding from smoking or asbestos exposure is still not resolved. This question was addressed in a cohort with a long follow-up and quantified estimates of individual exposure to welding fume particulates.
Male metal workers employed at least 1 year at one or more Danish stainless or mild steel industrial companies from 1964 through 1984 were enrolled in a cohort. Data on occupational and smoking history were obtained by questionnaire in 1986. Welders in the cohort who started welding in 1960 or later (N=4539) were followed from April 1968 until December 2003, when information on cancer diagnosis was obtained from the Danish Cancer Registry. During the follow-up, 75 cases of primary lung cancer were identified. Lifetime accumulated exposure to welding fume particulates was estimated by combining questionnaire information and more than 1000 welding-process-specific measurements of fume particulates in the Danish welding industry.
The standardized incidence ratio (SIR) for lung cancer was increased among the welders [SIR 1.35, 95% confidence interval (95% CI) 1.06-1.70)]. Among the stainless steel welders, the risk increased significantly with increasing accumulative welding particulate exposure, while no exposure-response relation was found for mild steel welders, even after adjustment for tobacco smoking and asbestos exposure.
The study corroborates earlier findings that welders have an increased risk of lung cancer. While exposure-response relations indicate carcinogenic effects related to stainless steel welding, it is still unresolved whether the mild steel welding process carries a carcinogenic risk.
焊工中观察到的肺癌风险升高是由焊接排放物引起，还是由吸烟或接触石棉的混杂因素导致，这一问题仍未得到解决。在一个进行了长期随访并对个体接触焊接烟尘颗粒进行了量化估计的队列中探讨了这个问题。
纳入1964年至1984年期间在丹麦一家或多家不锈钢或低碳钢工业公司工作至少1年的男性金属工人队列。1986年通过问卷调查获得职业和吸烟史数据。该队列中1960年或之后开始焊接的焊工（N = 4539）从1968年4月随访至2003年12月，此时从丹麦癌症登记处获取癌症诊断信息。在随访期间，确定了75例原发性肺癌病例。通过结合问卷调查信息和丹麦焊接行业1000多次特定焊接过程的烟尘颗粒测量，估计了焊接烟尘颗粒的终生累积暴露量。
焊工中肺癌的标准化发病比（SIR）升高[SIR 1.35，95%置信区间（95%CI）1.06 - 1.70]。在不锈钢焊工中，风险随着累积焊接颗粒暴露量的增加而显著增加，而对于低碳钢焊工，即使在调整了吸烟和石棉暴露因素后，也未发现暴露 - 反应关系。
该研究证实了早期的发现，即焊工患肺癌的风险增加。虽然暴露 - 反应关系表明与不锈钢焊接相关的致癌作用，但低碳钢焊接过程是否存在致癌风险仍未解决。
